P. P. Bapsy

Retroperitoneal inflammatory myofibroblastic tumor

BackgroundInflammatory myofibroblastic tumor (IMT) is a neoplasm of unknown etiology occurring at various sites. By definition, it is composed of spindle cells (myofibroblasts) with variable inflammatory component, hence the name is IMT.Case presentationThe present case is of a 46 years old woman presented with a history of flank pain, abdominal mass and intermittent hematuria for last 6 months. The initial diagnosis was kept as renal cell carcinoma. Finally, it turned out to be a case of retroperitoneal IMT. The patient was managed by complete surgical resection of the tumor.ConclusionIMT is a rare neoplasm of uncertain biological potential. Complete surgical resection remains the mainstay of the treatment.

Imatinib-induced optic neuritis in a patient of chronic myeloid leukemia

Imatinib is presently the commonest prescribes drug for patients of chronic myelogenous leukemia (CML) in chronic phase (CP) worldwide. Its ocular side effects are little known. Optic neuritis caused by this drug has not been reported (Medline search). We describe perhaps the first case of optic neuritis caused by this drug.

Bone metastasis in hepatocellular carcinoma: need for reappraisal of treatment.

Bone is an uncommon site of metastasis in patients with hepatocellular carcinoma (HCC), and often overlooked. We report two cases that had isolated bone metastasis; one of them had prolonged disease-free survival. The present series, along with the literature review, reinforces the idea that HCC should be considered in the differential diagnoses in patients presenting with metastases in bone. The presence of isolated bone metastases need not necessarily indicate poor prognosis, and all such patients need to be offered chemotherapy and at least one of the bone-directed therapies (either local radiation in cases of localized disease or bisphosphonates in the presence of extensive disease) as they may have a better outcome with therapy.

Unusual metastasis in colorectal cancer.

Metastasis from colorectal carcinoma occurs by either lymphatic or hematogenous spread. The most common sites of colorectal metastasis are the liver and lung. Involvement of the skin, muscles and bones are quite rare. The prognosis in such patients is usually poor. Herewith, we are reporting a case of colonic carcinoma who had cutaneous metastasis, muscular involvement and diffuse skeletal metastasis. At the end, she had brain metastasis, but liver and lung involvement was not observed till the end.

Irreversible sensorineural hearing loss due to Imatinib.

OBJECTIVE We report probably the first case of bilateral irreversible sensorineural hearing loss caused by Imatinib. METHOD A review of the world literature, concerning Imatinib toxicity is presented. RESULTS We report a case of bilateral irreversible sensorineural hearing loss, in a 19-year-old male patient of chronic myeloid leukemia after 3 months of Imatinib therapy. Audiometric evaluation documented the findings. CONCLUSION To the best of our knowledge, this is the first case report of Imatinib induced sensorineural hearing loss. This case indicates that treating oncologists should keep in mind that this drug too can produce ototoxicity.

A Prospective Randomized Study of Chop Versus Chop Plus Alpha-2B Interferon in Patients with Intermediate and High Grade Non-Hodgkin's Lymphoma: The International Oncology Study Group NHL1 Study

The addition of a brief alpha interferon regimen to each CHOP induction cycle, plus one year of alpha interferon thrice weekly maintenance therapy, has no early effect on response rates or survival in patients with Intermediate or High grade cell NHL. Background: The CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisone) regimen is the most widely used first-line therapy for patients with Intermediate or High Grade (IG/HG) non-Hodgkins lymphoma (NHL). Alpha 2b interferon (INF) enhances response rates and improves survival in low-grade NHL. The International Oncology Study Group (IOSG) conducted a prospective randomized study comparing CHOP alone or combined with INF in patients with IG/HG-NHL. The primary study aim was to compare the objective response rates in these patient cohorts. Patients and Methods: Patients with a confirmed diagnosis of measurable NHL of International Working Formulation (IWF) groups D to H histology were randomized to receive CHOP alone or CHOP with 5Mu INF SC for 5 days on days 22 to 26 of each 28 day cycle with INF 5 million units (Mu) given three times per week sub-cutaneously for 52 weeks in those patients who responded to CHOP plus INF. Results: The overall response rates were equivalent in both groups: CHOP alone (214 patients) 81% (complete 55%, partial 26%); CHOP plus INF (221 patients) 80% (complete 54%, partial 26%). At 36 months, the actuarial survival rate was equivalent in both groups. Conclusions: There is no apparent early advantage in terms of response or survival conferred by adding the study INF regimen to CHOP therapy for patients with IG/HG-NHL.

A multicenter phase II randomized study of Cremophor-free polymeric nanoparticle formulation of paclitaxel in women with locally advanced and/or metastatic breast cancer after failure of anthracycline.

Paclitaxel is extensively used in the treatment of advanced carcinomas of the breast, ovary and non‐small cell lung cancer. In clinical use it is formulated in the non‐ionic surfactant polyethoxylated castor oil (Cremophor) and dehydrated alcohol to enhance drug solubility. Cremophor adds to toxic effects of paclitaxel by producing or contributing to the well‐described hypersensitivity reactions that commonly occur during its infusion, affecting a large number of patients. This randomized trial was conducted to evaluate efficacy and safety of novel nanoparticle‐based paclitaxel in the treatment of patients with advanced breast cancer.

Impact of diabetes on cancer chemotherapy outcome: A retrospective analysis

BACKGROUND: Diabetes mellitus (DM) and cancer are common causes of morbidity and mortality. This study was designed to retrospectively study from hospital data the treatment outcome in three common cancers among our diabetic population. METHODOLOGY: Patients with histologically-proven breast, lung, or colorectal cancers were analyzed. Patients were stratiÞ ed into those with or without diabetes. Duration of diabetes, end-organ damage and glycemic control were recorded from the case records. “Response Evaluation Criteria In Solid Tumors” (RECIST) criteria were used to assess response. Common Toxicity Criteria, version 3.0, was used to assess toxicity. Disease-free and overall survival, as well as toxicity, were calculated for both groups and compared using the Student’s t test. RESULTS: A total of 119 diabetic patients who presented to the department of medical oncology over a 6-year period between 2000 and 2005, and who met the inclusion criteria, were analyzed. One control was chosen for each case randomly from the same population. Both groups were matched for baseline characteristics. The mean duration of diabetes was 2.6 years in the present study. Diabetics have signiÞ cantly lower response rates and poor overall and disease-free survival. The toxicity proÞ le is not different in both the groups. CONCLUSION: Our data supports the concept that DM is associated with an increase in mortality and poor response rates. This mechanism is probably independent of the glycemic control, comorbid conditions, or the treatment modality used for control of diabetics. We did not Þ nd any signiÞ cant increase in the complication rates in our diabetic patients. The possible reason for this clinical paradox could be the relatively good glycemic control: all the diabetics in the present study have near-normal blood sugar levels throughout.

Treatment outcome and cost-effectiveness analysis of two chemotherapeutic regimens (BEP vs. VIP) for poor-prognosis metastatic germ cell tumors.

BACKGROUND In patients with small-volume disseminated disease of germ cell tumors, cure can be achieved with four cycles of bleomycin, etoposide, and cisplatin (BEP). However, around 20% of these cases are not curable. Strategies to improve cure rates have shown that none of the currently available modalities were superior to the others. Among the most used ones, BEP and VIP (etoposide, cisplatin, and ifosfamide) have been the most studied. However, there are no reports comparing the two, except for a few in abstract forms from southern India. Therefore, we did a treatment outcome and cost-effectiveness analysis of two chemotherapeutic regimens (BEP vs VIP) that are used in poor-prognosis metastatic germ cell tumors. MATERIALS AND METHODS All male patients with germ cell tumors, diagnosed as having poor risk by IGCCCG, between January 2002 and December 2004 were included in the study. Clinical, laboratory, and other data were recorded. The patients were stratified into two categories on the basis of the type of chemotherapeutic regimen they received. RESULTS In all, 46 patients were analyzed, with a median follow up of 26.6 months. The baseline characteristics (age, stage, PS, histology, and serum markers) were not different in the two treatment arms. There is no significant difference in the outcome with either of the chemotherapeutic modalities. VIP is less cost effective and more toxic compared to BEP. CONCLUSION In view of the greater toxicity and cost of therapy, as well as lack of either overall or disease free survival advantage, VIP is not a preferred option for patients with high-risk germ cell tumors in the Indian setting and it is still advisable to treat patients with BEP.

A case of primary rhabdomyosarcoma of the breast.

Primary rhabdomyosarcoma of the breast is a rarely reported in adults, and it occurrence is mostly observed in children. We report a case of primary rhabdomyosarcoma of breast in a 40-year-old lady, who presented in early stage and is in complete remission after one year of treatment.